纤维支气管镜辅助治疗呼吸机相关性肺炎疗效的Meta分析

Efficacy of Fiberoptic Bronchoscopy in the Treatment of Ventilator-related Pneumonia:a Meta-analysis

目的:系统评价纤维支气管镜辅助治疗呼吸机相关性肺炎(Ventilator-associated pneumonia,VAP)的疗效、细菌清除率以及痰检阳性率。方法:制定主题词和自由词,计算机检索Cochrane Library、Pub Med、EMBASE、Science Direct、中国知网、维普、万方等数据库,检索纤维支气管镜辅助治疗VAP的随机对照实验(RCT)的文献。经过Jadad评分标准对所选文献进行筛查并用Excel表对数据进行提取整合。提取的数据用Rev Man 5.3统计软件进行Meta分析。结果:最终纳入31篇RCTs,在临床总有效率方面,纤维支气管镜辅助治疗组疗效显著高于常规治疗组(OR=4.95,95%CI=3.81~6.43,P<0.01)。在细菌清除率方面,纤维支气管镜辅助治疗组细菌清除率显著高于常规治疗组(OR=4.48,95%CI=2.78~7.21,P<0.01)。在痰检阳性率方面,纤维支气管镜辅助治疗组痰检阳性率显著高于常规治疗组(OR=2.56,95%CI=1.75~3.76,P<0.01)。结论:纤维支气管镜辅助治疗VAP疗效优于常规疗法,且细菌清除率高,痰检阳性率高,适于临床扩大推广使用。

Objective To systematically review the effetiveness,bacterial clearance and sputum smear positive rate of fiberbronchoscope treatment for ventilator-related pneumonia. Methods The randomized controlled trials（ RCTs） about fiberbronchoscope treatment for ventilator-related pneumonia were electronically retrieved from Cochrane Library,Pub Med,EMBASE,Science Direct,CNKI,VIP and Wanfang database using Medical Subject Headings（ Me SH） and（ or） keywords.The selected literature were screened by Jadad scoring criteria and the data were extracted and integrated with Excel. Meta-analysis was conducted on the extracted data using Rev Man 5.3 software. Results Thirty-one RCTs were included,and the total clinical efficiency of the fiberbronchoscope group was significantly higher than that of the conventional therapy group（ OR = 4.95,95%CI = 3.81 - 6.43,P 〈0.01）. The bacterial clearance rate of the fiberbronchoscope group was remarkably higher than that of the conventional treatment group（ OR = 4.48,95% CI = 2.78 - 7.21,P 〈0.01）,and the sputum positive rate of the fiberbronchoscope group was significantly higher than that of the conventional treatment group（ OR = 2. 56,95% CI = 1.75 - 3.76,P 〈0.01）. Conclusion Fiberbronchoscope treatment is much better than conventional therapy for ventilator associated pneumonia and has a better bacterial clearance rate and sputum positive rate. It is suitable for clinical application.